Like other areas of health care, hospice requires a lot of training, especially for nurses. From technology and compliance to standard operating procedures and continuing education requirements, it’s easy to overwhelm your team. Even after devoting countless hours to learning and development, many hospice nurses report feeling under-supported for some of the unique demands of their roles. What are we missing?
One area of opportunity is around building knowledge of some of the unique medications, medication protocols and treatment workflows that exist in hospice and palliative care. This can be a significant stressor for a variety of reasons that span clinical, administrative and interpersonal competencies. As a pharmacist with Enclara Pharmacia, a pharmacy benefit manager (PBM) for the hospice community, I have seen firsthand how organizations like ours can help lighten the load for nurses through clinical expertise, educational opportunities, workflow technology and other services.
Education Is Important
I joined Enclara as a clinical pharmacist manager, helping hospices optimize their medication utilization to support both quality improvement and cost containment. A big part of that involved the creation and delivery of educational programming for clinicians. One of my major takeaways was that hospice nurses out in the field spend the majority of their time working independently. They do an incredible job, but the work can be both physically and emotionally draining.
The right preparation and resources are essential to maximizing professional satisfaction for these everyday heroes. Today, as director of training and education, I lead a team responsible for the management of our Enclara Learning Academy, which provides live and on-demand professional development programs to help nurses master both clinical concepts and operational best practices in hospice medication management.
Pharmacist Support Improves the Nurse Experience
Clinical support is the defining feature of pharmacies and PBMs that specialize in hospice care. Each organization does things a little differently, but the common goal is to support patient safety and comfort. At Enclara, a team of pharmacists and technicians fields calls 24/7 to provide guidance on symptom management. Over the years, these calls have inspired a library of clinical resources and training sessions. At the same time, technology has transformed how we provide medications to patients, and it is important to educate nurses on how to get the most from our digital tools.
A lot of what we do starts with the acknowledgement that hospice and palliative care make up a small and unique niche within the larger health care system. Palliative care tends to receive less attention than other topics in both nursing school and continuing education curricula, so nurses entering the hospice sector typically do a lot of their learning on the job. Even experienced hospice nurses may have knowledge or skills gaps, which can negatively impact professional satisfaction.
Learning & Development Drives Confidence in Caregiving
Navigating difficult topics with patients and caregivers is a prime contributor to stress and frustration for hospice nurses. One of those areas is deprescribing, which means removing some medications from a patient’s pharmacy regimen. Many medications used for long-term health and prevention aren’t necessary in end-of-life care and may increase the risk of adverse drug events. However, there can be a lot of emotion attached to long-term treatments and what it means to stop them. That tension has made deprescribing one of our most requested topics.
A key area of focus is dealing with signs of normal disease progression that don’t cause discomfort to patients but can lead to concerns for family members. In each of our clinical sessions, we strive to help nurses understand both the “why” and “how” of palliative pharmacology so they can educate patients and caregivers and involve them in the decision-making process.
Another major stressor for hospice nurses is navigating the various workflows and systems required to deliver care for their patients. It’s an issue for clinicians in every specialty, but the demands of homecare and hospice can add additional layers of administration. Between documentation, scheduling and managing medications and medical supplies, nurses sometimes feel like they spend more time interacting with their tablet or laptop than with patients and their loved ones. A big part of my team’s job is training nurses on our medication management platform and electronic medical record integrations. Our goal is to help them use these tools efficiently so they can devote more time to patient care. This ties to our mantra: “You deliver the care, we make it easier.”
One of the things I love about this work is the feedback we get from nurses in our live sessions. This year we helped onboard several new hospice clients that were transitioning from direct pharmacy contracts to a PBM for the first time. While that kind of transition inevitably inspires some trepidation among hospice nurses, most of what we hear is excitement and relief about the resources available to support them in this difficult but essential work.
Hospices often think of PBMs just in terms of drug pricing, but there seems to be growing awareness that our industry can provide a wide range of benefits, including supporting staff retention through a high-quality nurse experience. Ultimately, the prime motivator for nurses is having the tools, knowledge and support to provide the best possible patient care. That’s something I’m proud to be part of.
